【作者】 郑学斌；

【导师】 黄全跃；

【作者基本信息】 中南大学 ， 内科学， 2007， 硕士

【摘要】 目的：测定冠心病患者与非冠心病对照者血栓调节蛋白(Thrombomodulin，TM)水平及冠心病患者的高敏C反应蛋白(high-sensitive C-reactive protein，hs-CRP)水平，了解TM与冠心病危险因素之间的关系；观察TM、hs-CRP在不同类型冠心病患者中的分布情况，并探讨其与冠心病近期(18个月左右)急性事件的关系。方法：本研究共纳入109例冠心病患者和63名健康对照者。取冠心病患者(包括急性冠脉综合征亚组、稳定型心绞痛亚组)和健康对照者血液各5ml，用酶联免疫吸附法测定两组血浆TM浓度，免疫透射比浊法检测冠心病组血浆hs-CRP浓度。对冠心病患者进行一年半左右的随访，追踪治疗情况及有无近期急性事件发生，用多因素logistic回归分析TM、hs-CRP与冠心病近期急性事件的关系。结果：(1)冠心病组血浆TM水平明显高于对照组(259.89±86.29ng／ml VS 204.44±65.83ng／ml，P＜0.05)。(2)稳定型心绞痛(SAP)亚组血浆TM水平较对照组明显升高(234.68±75.73ng／ml VS 204.44±65.83ng／ml，P＜0.05)；急性冠脉综合征(ACS)亚组血浆TM水平(286.53±89.39 ng／ml)较稳定型心绞痛亚组(234.68±75.73ng／ml)及对照组(204.44±65.83ng／ml)明显升高(P＜0.05)。(3)ACS亚组血清hs-CRP水平明显高于SAP亚组[32．10(2．19～28.12)mg／L VS 14.40(2.07～20.34)mg／L，P=0.039]。(4)血浆TM水平与高血压病、吸烟年支数等成正相关；与HDL-C水平成负相关。(5)TM(b=2.260，P=0.000，OR=9.586)、CRP(b=1.032，P=0.002，OR=2.806)均与冠心病近期急性事件明显相关，但TM具有更强的相关性。(6)TM(b=2.674，P=0.009，OR=14.492)、CRP(b=1.030，P=0.045，OR=2.801)均与ACS亚组近期急性事件明显相关，TM具有更强的相关性；而在SAP亚组中，TM、CRP均与近期急性事件无明显相关。结论(1)冠心病组血浆TM水平明显高于对照组。(2)血浆TM水平与高血压病、吸烟年支数成正相关；与血浆HDL-C水平成负相关。(3)血浆TM、hs-CRP水平能够反映冠心病患者病情严重程度。(4)血浆TM、hs-CRP水平可能均与冠心病近期急性事件的发生相关，尤其对于急性冠脉综合征患者来说可能更为显著。相对于hs-CRP而言，TM与冠心病急性事件发生的相关性可能更强。更多还原

【Abstract】 Objectives: The aim of this study was to investigate the levels of thrombomodulin and high-sensitive C-reactive protein of patients with acute coronary syndrome and stable angina pectoris so as to explore the relationship between levels of TM, CRP and the recurrent acute coronary events in the coming 18 months.Methods: Fasting blood samples were collected from one hundred and nine hospital-based patients with documented coronary heart disease (CHD) and 63 healthy controls, respectively. The patients with CHD were divided into two subgroups: acute coronary syndrome(n=53) and stable angina pectoris(n=56). Plasma TM was measured by enzyme-linked immunosorbent assay(ELISA) in all groups. Plasma hs-CRP of CHD patients was measured by immunoturbidimetry. The Patients with CHD were followed for 18 months. The correlation of the recurrent cardiovascular events and the levels of TM and hs-CRP of patients with CHD were analyzed by multiple variable logistic regression.Results:1. The plasma level of TM in patient with CHD was significantly higher than that in the control group(259.89±86.29ng/mlVS 204.44±65.83 ng/ml, P＜0.05).2. The plasma level of TM in the stable CHD subgroup was significantly higher than that of the control group(234.68±75.73ng/ml VS 204.44±65.83ng/ml, P＜0.05). The plasma level of TM in the ACS subgroup(286.53±89.39 ng/ml) was significantly higher than in the stable CHD subgroup(234.68±75.73ng/ml) and the control group (204.44±65.83ng/ml). The plasma level of TM from the SAP subgroup was significantly higher than that from the control group.3. Significantly higher plasma level of hs-CRP was observed in the ACS patients compared to the stable CHD subgroup[32.10(2.19～28.12) mg/L VS 14.40 (2.07～20.34), P=0.039].4. There were positive correlations between the plasma level of TM and hypertension and the pack-years of cigarette smoking, while there was a negative correlation between the plasma level of TM and high density lipoprotein cholesterol.5. The plasma level of TM(b-2.260, P=0.000, OR=9.586) and CRP (b-1.032, P=0.002, OR=2.806) were strongly correlated with the acute events of CHD (b=1.93, P=0.000, OR=6.86) respectively. The correlation between the TM level and acute events was stronger than the hs-CRP level。6. The plasma level of TM(b=2.674, P=0.009, OR=14.492) and CRP (b=1.030, P=0.045, OR=2.801) were strongly correlated with the acute events of the ACS subgroup respectively. The correlation between the TM level and acute events was stronger than the hs-CRP level. Nevertheless, TM and hs-CRP had no significant correlation with the SAP subgroup. Conclusions:(1) The plasma level of TM in patient with CHD is significantly higher than that in the control group.(2) There is a positive correlation between the plasma level of TM and hypertension and smoking respectively, while there is a negative correlation between the plasma level of TM and high density lipoprotein cholesterol.(3) The plasma level of TM and hs-CRP can reflect the extent and severity of CHD respectively.(4) Both TM and hs-CRP may have positive correlations with the acute events of CHD, especially of the ACS patients. Moreover, TM may have a stronger correlation with the acute events of CHD than hs-CRP.更多还原